Association between a hospitalization for heart failure and the initiation/discontinuation of guideline-recommended treatments : An analysis from the Swedish Heart Failure Registry
© 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology..
AIMS: To investigate whether a heart failure (HF) hospitalization is associated with initiation/discontinuation of guideline-directed medical HF therapy (GDMT) and consequent outcomes.
METHODS AND RESULTS: Among patients in the Swedish HF registry with an ejection fraction <50% enrolled in 2009-2018, initiation/discontinuation of GDMT was investigated by assessing dispensations of GDMT in those with versus without a HF hospitalization. Of 14 737 patients, 6893 (47%) were enrolled when hospitalized for HF. Initiation of GDMT was more likely than discontinuation following a HF hospitalization compared to a control group of patients without a HF hospitalization (odds ratio range 2.1-4.0 vs. 1.4-1.6 for the individual medications), although the proportion of patients not on GDMT was still high (8.1-44.0%). Key patient characteristics triggering less use of GDMT (i.e. less initiation or more discontinuation) were older age and worse renal function. Following a HF hospitalization, initiation of renin-angiotensin system inhibitors/angiotensin receptor-neprilysin inhibitors or beta-blockers was associated with lower and their discontinuation with higher mortality risk, but no association with mortality was observed for initiation/discontinuation of mineralocorticoid receptor antagonists.
CONCLUSIONS: Following a HF hospitalization, initiation of GDMT was more likely than discontinuation, although still limited. Perceived or actual low tolerance were barriers to GDMT implementation. Early re-/initiation of GDMT was associated with better survival. Our findings represent a call for further implementing the current guideline recommendation for an early re-/initiation of GDMT following a HF hospitalization.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:25 |
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| Enthalten in: |
European journal of heart failure - 25(2023), 7 vom: 28. Juli, Seite 1132-1144 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Schrage, Benedikt [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 09.08.2023 Date Revised 09.08.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1002/ejhf.2928 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM358191890 |
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| 041 | |a eng | ||
| 100 | 1 | |a Schrage, Benedikt |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Association between a hospitalization for heart failure and the initiation/discontinuation of guideline-recommended treatments |b An analysis from the Swedish Heart Failure Registry |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 09.08.2023 | ||
| 500 | |a Date Revised 09.08.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. | ||
| 520 | |a AIMS: To investigate whether a heart failure (HF) hospitalization is associated with initiation/discontinuation of guideline-directed medical HF therapy (GDMT) and consequent outcomes | ||
| 520 | |a METHODS AND RESULTS: Among patients in the Swedish HF registry with an ejection fraction <50% enrolled in 2009-2018, initiation/discontinuation of GDMT was investigated by assessing dispensations of GDMT in those with versus without a HF hospitalization. Of 14 737 patients, 6893 (47%) were enrolled when hospitalized for HF. Initiation of GDMT was more likely than discontinuation following a HF hospitalization compared to a control group of patients without a HF hospitalization (odds ratio range 2.1-4.0 vs. 1.4-1.6 for the individual medications), although the proportion of patients not on GDMT was still high (8.1-44.0%). Key patient characteristics triggering less use of GDMT (i.e. less initiation or more discontinuation) were older age and worse renal function. Following a HF hospitalization, initiation of renin-angiotensin system inhibitors/angiotensin receptor-neprilysin inhibitors or beta-blockers was associated with lower and their discontinuation with higher mortality risk, but no association with mortality was observed for initiation/discontinuation of mineralocorticoid receptor antagonists | ||
| 520 | |a CONCLUSIONS: Following a HF hospitalization, initiation of GDMT was more likely than discontinuation, although still limited. Perceived or actual low tolerance were barriers to GDMT implementation. Early re-/initiation of GDMT was associated with better survival. Our findings represent a call for further implementing the current guideline recommendation for an early re-/initiation of GDMT following a HF hospitalization | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Discontinuation | |
| 650 | 4 | |a Guideline-directed medical therapy | |
| 650 | 4 | |a Guidelines | |
| 650 | 4 | |a Heart failure with mildly reduced ejection fraction | |
| 650 | 4 | |a Heart failure with reduced ejection fraction | |
| 650 | 4 | |a Implementation | |
| 650 | 4 | |a Initiation | |
| 650 | 7 | |a Angiotensin-Converting Enzyme Inhibitors |2 NLM | |
| 650 | 7 | |a Adrenergic beta-Antagonists |2 NLM | |
| 650 | 7 | |a Angiotensin Receptor Antagonists |2 NLM | |
| 700 | 1 | |a Lund, Lars H |e verfasserin |4 aut | |
| 700 | 1 | |a Benson, Lina |e verfasserin |4 aut | |
| 700 | 1 | |a Braunschweig, Frieder |e verfasserin |4 aut | |
| 700 | 1 | |a Ferreira, João Pedro |e verfasserin |4 aut | |
| 700 | 1 | |a Dahlström, Ulf |e verfasserin |4 aut | |
| 700 | 1 | |a Metra, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Rosano, Giuseppe M C |e verfasserin |4 aut | |
| 700 | 1 | |a Savarese, Gianluigi |e verfasserin |4 aut | |
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